Unified Health

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Our client is Unified Health, a health care company in the US. It insures patients and provides health care services. Employers pay a premium to UH for their employees and UH covers all necessary medical costs. UH has 300,000 patients enrolled. It has 300 salaried physicians covering 6 health centers which aren't owned by UH, but UH contracts local hospitals. If a patient needs medical care not covered by a UH physician, the patient is reffered outside the network and UH pays for all costs.

Over the past 6 months UH has suffered declining profitability and you are hired to figure out what is wrong. 



I. Background

What areas would you want to explore to understand the client's decline in profitability?

II. Analysis – 1

After a thorough analysis, we discovered that UH has a big problem in the way it manages her medical costs, in particular the costs of referrals to specialists outside the UH network. As a benchmark, we have collected data on the average cost of referral for UH and its main competitor. What do you think is the cause for the higher referral cost at UH?

II. Analysis – 2

UH CEO mentions that they pay too much in cardiology referral costs. He asks us to look closer at his cardiac patient population to see how many referrals he should expect on an annual basis.

II. Analysis – 3

After hearing that UH should expect around 200,000 referral visits, he mentions that UH currently pays for 300,000 referral visits. What do you think causes the difference here?

III. Solution

You come across the CEO in the hall and he asks you to quickly summarize findings & recommendations. How do you address him?

Weitere Fragen

  • Do you think UH could solve this issue by not accepting people of 65 or older into their insurance program?
  • What barriers might present itself to such a solution?
20,1 T.
mal gelöst
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